AASLD Abstracts Pooled fibrosis progression rate in patients with nonalcoholic steatohepatitis, and baseline stage 0 fibrosis. Effect size represents the annual rate of progression of fibrosis stage. Sa1053 High Hepatic Iron and Low Serum Betaine Levels Are Associated With Hepatic Steatosis Among Males With Chronic Hepatitis B Asad Javaid, Allison B. Goldfine, Mary-Elizabeth Patti, Ping Ping Kuang, Peymei Wu, Teodoro Bottiglieri, Imad Nasser, Daryl Lau Nonalcoholic fatty liver disease (NAFLD) is an important cause of liver disease. The prevalence of hepatic steatosis in chronic hepatitis B (CHB) is not well understood. There are reports that low betaine level contributes to hepatic steatosis by increasing oxidative stress. Our aims are to determine the prevalence and impact of hepatic steatosis on CHB and the role of betaine in this disease state. In a single center, CHB patients with pretreatment liver biopsy between 1998 and 2013 were reviewed. The analysis excluded patients with alcohol- ism (>50g/day), HCV, HDV or HIV coinfection, other liver diseases and liver transplantation. To date, 231 patients (75% Asians) met the inclusion criteria. Serum betaine levels were measured in 40 randomly selected serum samples from patients with and without steatosis in both genders. Results: Total 127 (55%) pts had hepatic steatosis in biopsied tissue. Steatosis was more common in males (91/136, 67%) than females (36/95, 38%) [p=0.0001]. Among those with steatosis, males (mean 41.5 yrs) were younger than females (mean 48.5 yrs) [p=0.02]. For both genders, those with steatosis had higher rate of severe hepatic inflammation (M 63%, F 30%) compared to those without (M 5%, F 3%) [p=0.0001]. Advanced fibrosis (Stage 3+4) was more frequent in males (14%) than females (8%). Hepatic iron was present in 47 of 91 (52%) males with steatosis but in only 7 of 36 (19%) females with steatosis [p=0.0001]. Females with steatosis had higher rates of elevated LDL cholesterol (64% vs. 41%) [p=0.04], triglyceride (31% vs.13%) [p=0.02] and increased body weight (150lbs vs. 126lbs) [p=0.001] compared to those without. The lipid profiles and weight, however, were similar in males with and without steatosis. Interestingly, males with steatosis (N=10) had lower serum level of betaine compared those without steatosis (N=10) [28.3 vs. 43.3 umol/L; p=0.056]. In contrast, females with (N=10) or without steatosis (N=10) had similar betaine levels [42.9 vs. 39.3umol/L; p=0.3]. Viral factors such as serum HBV DNA levels, HBeAg status were not different between those with and without steatosis. Conclusions: High prevalence of hepatic steatosis is identified in this predominantly Asian cohort of patients with chronic hepatitis B. Steatosis is more common in males. For both genders, steatosis is associated with more severe hepatic inflammation. There appears to be a gender difference in predisposition to steatosis. In females, metabolic syndrome is a major contributing factor. In males, presence of hepatic iron and lower betaine levels correlate with steatosis and inflammation. It is possible that betaine attenuates iron-iduced oxidative stress in the liver. The gender differences in steatosis predisposition in CHB warrant further evaluation. Its understanding likely will contribute to better preventive and therapeutic strate- gies. Sa1054 Clinical Model for NASH or Advanced Fibrosis in Patients With Diabetes and NAFLD Jessica Bazick, Michele Donithan, Brent A. Neuschwander-Tetri, David E. Kleiner, Elizabeth Brunt, Laura Wilson, Edward Doo, Joel E. Lavine, Rohit Loomba Background and aims: Approximately 18 million people in the United States have co-existing type 2 diabetes with NAFLD. It is not known who among these diabetic NAFLD patients has nonalcoholic steatohepatitis (NASH) or advanced fibrosis. Therefore, we aimed to determine factors that are associated with NASH or advanced fibrosis in diabetic patients with NAFLD in order to identify who should be prioritized for a liver biopsy or referred to a hepatologist for diagnostic evaluation and treatment. Methods: This prospective cohort study was derived from the NASH Clinical Research Network studies and included 1249 patients with biopsy- proven NAFLD (including 441 with type 2 diabetes as defined by the American Diabetes Association Criteria). Two clinical models for presence of NASH and advanced fibrosis (stage ≥3) were developed with multiple logistic regression and cross-validated jack-knife methodology to obtain adjusted area under the receiver operator characteristic curves (AUROC) and their 95% confidence interval (CI). Results: The mean (±standard deviation) age and body-mass-index (BMI) of patients with diabetes and NAFLD was 52.4 ± 10.5 years and 35.8 ± 6.6 kg/m2, respectively. The prevalence of NASH and advanced fibrosis was S-948 AASLD Abstracts 68.3% and 40.4%, respectively. The model for predicting NASH included age, BMI, waist- to-hip ratio, ALT, AST, total bilirubin, albumin, HbA1c, HOMA-IR, HDL cholesterol, hemato- crit, INR, and platelet count with a cross-validated AUROC of 0.81 (95% CI; 0.77 - 0.85). The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were 90.4%, 46.5%, 44.4%, and 91.1%, respectively, and the model correctly classified 60.6% of patients as having NASH. The model for predicting advanced fibrosis included age, BMI, waist-to-hip ratio, hypertension, ALT, AST, alkaline phosphatase, GGT, globulin, albumin, serum insulin, hematocrit, INR, and platelet count with a cross-validated AUROC of 0.82 (95% CI; 0.78 - 0.85). The specificity, sensitivity, NPV, and PPV were 90.2%, 56.3%, 75.2%, and 79.7%, respectively, and the model correctly classified 76.5% of patients as having advanced fibrosis. Conclusions: Routinely available clinical variables can be utilized to determine the likelihood of NASH or advanced fibrosis in diabetic patients with NAFLD. These data can guide clinicians when to refer the diabetic patients to a liver specialist. Sa1055 Use of Insulin and Sulfonylurea Is Associated With Hepatic Fibrosis in Diabetic Patients With Non-Alcoholic Fatty Liver Disease George Boon-Bee Goh, Jaividhya Dasarathy, Mangesh R. Pagadala, Aynur Unalp, Carol Hawkins, Ruth Sargent, Achuthan Sourianarayanane, Rish Pai, Lisa Yerian, Amer Khiyami, Srinivasan Dasarathy, Arthur J. McCullough Background: Type 2 diabetes mellitus (DM) is an established risk factor for advanced fibrosis and the development of NASH in Non-alcoholic fatty liver disease (NAFLD). However, not all diabetic patients with NASH develop advanced fibrosis. We hypothesized that medications taken by these patients may have influenced the development of advanced fibrosis in the setting of NAFLD. Aims: We explored the association between commonly used medications and advanced fibrosis in diabetic patients with NAFLD We also sought to confirm the close relationship between DM and advanced fibrosis in a cohort of biopsy proven NAFLD. Methods: The study cohort included 459 patients with biopsy proven NAFLD being followed up in the liver clinics at the Cleveland Clinic and MetroHealth Medical Centre in Cleveland, OH. Clinical information including demographics, anthropometry, medical history, concomi- tant medication history, biochemical and histological variables were ascertained. Risk factors for advanced fibrosis were explored, with advanced fibrosis defined as stage 3 or 4 fibrosis. We also compared the baseline characteristics of patients with and without DM. Risk factors for advanced fibrosis among the DM patients, specifically commonly used medications that were taken concomitantly were evaluated. Results: Age, presence of DM, total cholesterol, low density lipoprotein cholesterol and ballooning were independent risk factors for advanced fibrosis in NAFLD patients. Compared to non-DM patients, DM patients were older (52.16 vs. 46.03 years; p=0.000), with greater proportion of female gender (69.1 vs. 52.9%; p= 0.000), higher BMI (37.01 vs. 35.04 kg/m2; p=0.014) and higher prevalence of concomitant hypertension (70.9 vs. 43.1%; p=0.000) DM patients also had more lobular inflammation, ballooning and advanced fibrosis compared to non-DM patients. Amongst the DM patients, age (OR 1.091; 95%CI 1.039-1.146, p=0.000) and grade of ballooning (OR 5.586; 95%CI 2.687-11.611, p=0.000) had a positive relationship with advanced fibrosis. In addition, concomitant use of insulin (OR 4.950; 95%CI 1.647-14.880, p=0.004) and sulfonylurea (OR 5.070; 95%CI 1.870-13.745, p=0.001) were positively associated while statin use (OR 0.305; 95%CI 0.120-0.776, p=0.013) was negatively associated with advanced fibrosis. Conclusion: Presence of DM is a significant risk factor for advanced fibrosis in NAFLD. Amongst DM patients with NAFLD, the prevalence of advanced fibrosis was higher in patients treated with insulin and sulfonylurea, and was lower in patients treated with statins. These findings may provide support for statin use in diabetic patients with NAFLD while limiting the use of insulin and sulfonylurea as preferred hypoglycaemic agents in these patients. Sa1056 Association of Nonalcoholic Fatty Liver Disease With Liver Malignancies Perla O. Schulz, Andrea Vieira, Maria de Fátima A. Nascimento, Fabio G. Ferreira, Mauricio A. Ribeiro, Luiz A. Szutan Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing worldwide. The relation among non-alcoholic steatohepatitis (NASH) cirrhosis and hepatocel- lular carcinoma (HCC) or intrahepatic cholangiocarcinoma (IHCC) has been reported, but it is still unknown if such associations exist in non-cirrhotic patients. Furthermore, it has been suggested that early stages of hepatic steatosis can already be considered a favorable microenvironment for the development of liver metastases of colorectal neoplasms (LMCN). Aims: To evaluate the association of NAFLD with primary and secondary malignancies of the liver and to compare the prevalence of this association in different tumor types. Methods: This was a retrospective study based on data from the anatomopathology records of 180 patients with hepatic neoplasms treated in a referral center of Brazil, from January 2007 to December 2011. Were excluded 60 patients due to previously known liver disease (viral hepatitis, alcohol abuse, autoimmune hepatitis, hemochromatosis and Wilson's disease), or absence of liver tissue free of tumor at histology material. We divided the remaining 120 cases in groups by type of cancer and a comparison was made among them, for each histological type. The histological samples were evaluated for the presence of hepatic steatosis, NASH and liver fibrosis. The presence of risk factors for NAFLD (glucose intolerance and/ or diabetes mellitus, dyslipidemia, arterial hypertension and overweight) was checked and the association of these predictors with the histological findings was quantified. Institution Ethic Committee approved the study and the statistical analysis was performed with the Statistical Package for Social Sciences (SPSS) version 13.0 and Epi Info version 3.4.3. The significance level for all tests was 5% (p < 0,05). Results: Both groups of each liver tumor were comparable regarding age and gender (Table 1). There was no difference in the association of hepatic steatosis with the general population (34.2% and 30% respectively, 95% CI: 25.8 to 43.4). The hepatic steatosis was more prevalent in patients with LMCN while the prevalence of liver fibrosis was higher in the HCC group (Table 2). No case of NASH in combination with any of the three tumor types was observed. Regarding the relationship of hepatic steatosis, NASH and liver fibrosis with risk factors, no association was found statistically significant in any of the tumors studied. Conclusion: NAFLD is